|
HCHG CYTOPATH CONC SM & INTERP
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
HCPCS 88108
|
| Hospital Charge Code |
H3110160
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$219.30 |
| Max. Negotiated Rate |
$250.26 |
| Rate for Payer: Cash Price |
$167.70
|
| Rate for Payer: Health Management Network Commercial |
$219.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$232.20
|
| Rate for Payer: MDX Hawaii PPO |
$250.26
|
|
|
HCHG CYTOPATH CONC SM & INTERP
|
Facility
|
OP
|
$258.00
|
|
|
Service Code
|
HCPCS 88108
|
| Hospital Charge Code |
H3110160
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$31.77 |
| Max. Negotiated Rate |
$255.42 |
| Rate for Payer: AlohaCare Medicaid |
$129.00
|
| Rate for Payer: AlohaCare Medicare |
$232.20
|
| Rate for Payer: Cash Price |
$167.70
|
| Rate for Payer: Cash Price |
$167.70
|
| Rate for Payer: Devoted Health Medicare |
$255.42
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$44.09
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$47.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$232.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$31.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$38.16
|
| Rate for Payer: Health Management Network Commercial |
$219.30
|
| Rate for Payer: Humana Medicare |
$232.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$232.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$131.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$232.20
|
| Rate for Payer: MDX Hawaii PPO |
$250.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$232.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$232.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$44.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$232.20
|
| Rate for Payer: University Health Alliance Commercial |
$143.97
|
|
|
HCHG CYTOPATH MEDICAL CONCENTRATION
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
HCPCS 88108
|
| Hospital Charge Code |
H3110279
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$31.77 |
| Max. Negotiated Rate |
$295.02 |
| Rate for Payer: AlohaCare Medicaid |
$149.00
|
| Rate for Payer: AlohaCare Medicare |
$268.20
|
| Rate for Payer: Cash Price |
$193.70
|
| Rate for Payer: Cash Price |
$193.70
|
| Rate for Payer: Devoted Health Medicare |
$295.02
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$44.09
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$47.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$268.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$31.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$38.16
|
| Rate for Payer: Health Management Network Commercial |
$253.30
|
| Rate for Payer: Humana Medicare |
$268.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$268.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$151.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$268.20
|
| Rate for Payer: MDX Hawaii PPO |
$289.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$268.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$268.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$44.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$268.20
|
| Rate for Payer: University Health Alliance Commercial |
$143.97
|
|
|
HCHG CYTOPATH MEDICAL CONCENTRATION
|
Facility
|
IP
|
$298.00
|
|
|
Service Code
|
HCPCS 88108
|
| Hospital Charge Code |
H3110279
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$253.30 |
| Max. Negotiated Rate |
$289.06 |
| Rate for Payer: Cash Price |
$193.70
|
| Rate for Payer: Health Management Network Commercial |
$253.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$268.20
|
| Rate for Payer: MDX Hawaii PPO |
$289.06
|
|
|
HCHG D-DIMER QUANT
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
HCPCS 85379
|
| Hospital Charge Code |
H3050128
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$159.80 |
| Max. Negotiated Rate |
$182.36 |
| Rate for Payer: Cash Price |
$122.20
|
| Rate for Payer: Health Management Network Commercial |
$159.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$169.20
|
| Rate for Payer: MDX Hawaii PPO |
$182.36
|
|
|
HCHG D-DIMER QUANT
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
HCPCS 86334
|
| Hospital Charge Code |
H3020608
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$132.60 |
| Max. Negotiated Rate |
$151.32 |
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Health Management Network Commercial |
$132.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$140.40
|
| Rate for Payer: MDX Hawaii PPO |
$151.32
|
|
|
HCHG D-DIMER QUANT
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
HCPCS 85379
|
| Hospital Charge Code |
H3050128
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$186.12 |
| Rate for Payer: AlohaCare Medicaid |
$94.00
|
| Rate for Payer: AlohaCare Medicare |
$169.20
|
| Rate for Payer: Cash Price |
$122.20
|
| Rate for Payer: Cash Price |
$122.20
|
| Rate for Payer: Devoted Health Medicare |
$186.12
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.06
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$12.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$169.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$14.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.18
|
| Rate for Payer: Health Management Network Commercial |
$159.80
|
| Rate for Payer: Humana Medicare |
$169.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$169.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$95.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$169.20
|
| Rate for Payer: MDX Hawaii PPO |
$182.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$169.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$169.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$169.20
|
| Rate for Payer: University Health Alliance Commercial |
$26.31
|
|
|
HCHG D-DIMER QUANT
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
HCPCS 86334
|
| Hospital Charge Code |
H3020608
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.34 |
| Max. Negotiated Rate |
$154.44 |
| Rate for Payer: AlohaCare Medicaid |
$78.00
|
| Rate for Payer: AlohaCare Medicare |
$140.40
|
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Devoted Health Medicare |
$154.44
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$30.87
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$27.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$140.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$32.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$22.34
|
| Rate for Payer: Health Management Network Commercial |
$132.60
|
| Rate for Payer: Humana Medicare |
$140.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$140.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$79.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$140.40
|
| Rate for Payer: MDX Hawaii PPO |
$151.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$140.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$140.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$30.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$140.40
|
| Rate for Payer: University Health Alliance Commercial |
$57.74
|
|
|
HCHG DEBRIDE ECZEMA OR INFECT SKIN
|
Facility
|
OP
|
$3,187.00
|
|
|
Service Code
|
HCPCS 11000
|
| Hospital Charge Code |
H4500364
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$3,155.13 |
| Rate for Payer: AlohaCare Medicaid |
$1,593.50
|
| Rate for Payer: AlohaCare Medicare |
$2,868.30
|
| Rate for Payer: Cash Price |
$2,071.55
|
| Rate for Payer: Cash Price |
$2,071.55
|
| Rate for Payer: Devoted Health Medicare |
$3,155.13
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,868.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,027.65
|
| Rate for Payer: Health Management Network Commercial |
$2,708.95
|
| Rate for Payer: Humana Medicare |
$2,868.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,868.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,868.30
|
| Rate for Payer: MDX Hawaii PPO |
$3,091.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,868.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,868.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,868.30
|
| Rate for Payer: University Health Alliance Commercial |
$2,323.00
|
|
|
HCHG DEBRIDE ECZEMA OR INFECT SKIN
|
Facility
|
IP
|
$3,187.00
|
|
|
Service Code
|
HCPCS 11000
|
| Hospital Charge Code |
H4500364
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,708.95 |
| Max. Negotiated Rate |
$3,091.39 |
| Rate for Payer: Cash Price |
$2,071.55
|
| Rate for Payer: Health Management Network Commercial |
$2,708.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,868.30
|
| Rate for Payer: MDX Hawaii PPO |
$3,091.39
|
|
|
HCHG DEBRIDEMENT MUSCLE/FASCIA, 1ST 20 SQ CM OR LESS
|
Facility
|
OP
|
$3,187.00
|
|
|
Service Code
|
HCPCS 11043
|
| Hospital Charge Code |
H4500380
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$1,593.50
|
| Rate for Payer: AlohaCare Medicare |
$2,868.30
|
| Rate for Payer: Cash Price |
$2,071.55
|
| Rate for Payer: Cash Price |
$2,071.55
|
| Rate for Payer: Devoted Health Medicare |
$3,155.13
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,868.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,027.65
|
| Rate for Payer: Health Management Network Commercial |
$2,708.95
|
| Rate for Payer: Humana Medicare |
$2,868.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,868.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,868.30
|
| Rate for Payer: MDX Hawaii PPO |
$3,091.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,868.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,868.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,868.30
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HCHG DEBRIDEMENT MUSCLE/FASCIA, 1ST 20 SQ CM OR LESS
|
Facility
|
IP
|
$3,187.00
|
|
|
Service Code
|
HCPCS 11043
|
| Hospital Charge Code |
H4500380
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,708.95 |
| Max. Negotiated Rate |
$3,091.39 |
| Rate for Payer: Cash Price |
$2,071.55
|
| Rate for Payer: Health Management Network Commercial |
$2,708.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,868.30
|
| Rate for Payer: MDX Hawaii PPO |
$3,091.39
|
|
|
HCHG DEBRIDE OF NAIL (1-5)
|
Facility
|
IP
|
$428.00
|
|
|
Service Code
|
HCPCS 11720
|
| Hospital Charge Code |
H4500366
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$363.80 |
| Max. Negotiated Rate |
$415.16 |
| Rate for Payer: Cash Price |
$278.20
|
| Rate for Payer: Health Management Network Commercial |
$363.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$385.20
|
| Rate for Payer: MDX Hawaii PPO |
$415.16
|
|
|
HCHG DEBRIDE OF NAIL (1-5)
|
Facility
|
OP
|
$428.00
|
|
|
Service Code
|
HCPCS 11720
|
| Hospital Charge Code |
H4500366
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$214.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$214.00
|
| Rate for Payer: AlohaCare Medicare |
$385.20
|
| Rate for Payer: Cash Price |
$278.20
|
| Rate for Payer: Cash Price |
$278.20
|
| Rate for Payer: Devoted Health Medicare |
$423.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$385.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$406.60
|
| Rate for Payer: Health Management Network Commercial |
$363.80
|
| Rate for Payer: Humana Medicare |
$385.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$385.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$385.20
|
| Rate for Payer: MDX Hawaii PPO |
$415.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$385.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$385.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$385.20
|
| Rate for Payer: University Health Alliance Commercial |
$311.97
|
|
|
HCHG DEBRIDE, OPEN WOUND, ASSESS & INSTRUC CARE, PER SESSION, 1ST 20 SQ CM OR LESS
|
Facility
|
OP
|
$554.00
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
H4501021
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$277.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$277.00
|
| Rate for Payer: AlohaCare Medicare |
$498.60
|
| Rate for Payer: Cash Price |
$360.10
|
| Rate for Payer: Cash Price |
$360.10
|
| Rate for Payer: Devoted Health Medicare |
$548.46
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$498.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$526.30
|
| Rate for Payer: Health Management Network Commercial |
$470.90
|
| Rate for Payer: Humana Medicare |
$498.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$498.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$498.60
|
| Rate for Payer: MDX Hawaii PPO |
$537.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$498.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$498.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$498.60
|
| Rate for Payer: University Health Alliance Commercial |
$403.81
|
|
|
HCHG DEBRIDE, OPEN WOUND, ASSESS & INSTRUC CARE, PER SESSION, 1ST 20 SQ CM OR LESS
|
Facility
|
IP
|
$554.00
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
H4501021
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$470.90 |
| Max. Negotiated Rate |
$537.38 |
| Rate for Payer: Cash Price |
$360.10
|
| Rate for Payer: Health Management Network Commercial |
$470.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$498.60
|
| Rate for Payer: MDX Hawaii PPO |
$537.38
|
|
|
HCHG DEBRIDE OPN FX/DISLOC
|
Facility
|
OP
|
$3,592.00
|
|
|
Service Code
|
HCPCS 11010
|
| Hospital Charge Code |
H4500368
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$3,556.08 |
| Rate for Payer: AlohaCare Medicaid |
$1,796.00
|
| Rate for Payer: AlohaCare Medicare |
$3,232.80
|
| Rate for Payer: Cash Price |
$2,334.80
|
| Rate for Payer: Cash Price |
$2,334.80
|
| Rate for Payer: Devoted Health Medicare |
$3,556.08
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,232.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,412.40
|
| Rate for Payer: Health Management Network Commercial |
$3,053.20
|
| Rate for Payer: Humana Medicare |
$3,232.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,232.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,232.80
|
| Rate for Payer: MDX Hawaii PPO |
$3,484.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,232.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,232.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,232.80
|
| Rate for Payer: University Health Alliance Commercial |
$2,618.21
|
|
|
HCHG DEBRIDE OPN FX/DISLOC
|
Facility
|
IP
|
$3,592.00
|
|
|
Service Code
|
HCPCS 11010
|
| Hospital Charge Code |
H4500368
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,053.20 |
| Max. Negotiated Rate |
$3,484.24 |
| Rate for Payer: Cash Price |
$2,334.80
|
| Rate for Payer: Health Management Network Commercial |
$3,053.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,232.80
|
| Rate for Payer: MDX Hawaii PPO |
$3,484.24
|
|
|
HCHG DEBRIDE SKIN/SQ/MUSC/BONE
|
Facility
|
OP
|
$6,176.00
|
|
|
Service Code
|
HCPCS 11044
|
| Hospital Charge Code |
H4500382
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$6,114.24 |
| Rate for Payer: AlohaCare Medicaid |
$3,088.00
|
| Rate for Payer: AlohaCare Medicare |
$5,558.40
|
| Rate for Payer: Cash Price |
$4,014.40
|
| Rate for Payer: Cash Price |
$4,014.40
|
| Rate for Payer: Devoted Health Medicare |
$6,114.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5,558.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5,867.20
|
| Rate for Payer: Health Management Network Commercial |
$5,249.60
|
| Rate for Payer: Humana Medicare |
$5,558.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,558.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$5,558.40
|
| Rate for Payer: MDX Hawaii PPO |
$5,990.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5,558.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$5,558.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$5,558.40
|
| Rate for Payer: University Health Alliance Commercial |
$4,501.69
|
|
|
HCHG DEBRIDE SKIN/SQ/MUSC/BONE
|
Facility
|
IP
|
$6,176.00
|
|
|
Service Code
|
HCPCS 11044
|
| Hospital Charge Code |
H4500382
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5,249.60 |
| Max. Negotiated Rate |
$5,990.72 |
| Rate for Payer: Cash Price |
$4,014.40
|
| Rate for Payer: Health Management Network Commercial |
$5,249.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,558.40
|
| Rate for Payer: MDX Hawaii PPO |
$5,990.72
|
|
|
HCHG DEBRIDE SKIN & SUBQ TISS
|
Facility
|
OP
|
$2,246.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
H4500374
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$5,160.40 |
| Rate for Payer: AlohaCare Medicaid |
$1,123.00
|
| Rate for Payer: AlohaCare Medicare |
$2,021.40
|
| Rate for Payer: Cash Price |
$1,459.90
|
| Rate for Payer: Cash Price |
$1,459.90
|
| Rate for Payer: Devoted Health Medicare |
$2,223.54
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,021.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,133.70
|
| Rate for Payer: Health Management Network Commercial |
$1,909.10
|
| Rate for Payer: Humana Medicare |
$2,021.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,021.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,021.40
|
| Rate for Payer: MDX Hawaii PPO |
$2,178.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,021.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,021.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,021.40
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HCHG DEBRIDE SKIN & SUBQ TISS
|
Facility
|
IP
|
$2,246.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
H4500374
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,909.10 |
| Max. Negotiated Rate |
$2,178.62 |
| Rate for Payer: Cash Price |
$1,459.90
|
| Rate for Payer: Health Management Network Commercial |
$1,909.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,021.40
|
| Rate for Payer: MDX Hawaii PPO |
$2,178.62
|
|
|
HCHG DECALCIFICATION PROCED
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
HCPCS 88311
|
| Hospital Charge Code |
H3120130
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Health Management Network Commercial |
$81.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$86.40
|
| Rate for Payer: MDX Hawaii PPO |
$93.12
|
|
|
HCHG DECALCIFICATION PROCED
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
HCPCS 88311
|
| Hospital Charge Code |
H3120130
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$95.04 |
| Rate for Payer: AlohaCare Medicaid |
$48.00
|
| Rate for Payer: AlohaCare Medicare |
$86.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Devoted Health Medicare |
$95.04
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$12.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$86.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$91.20
|
| Rate for Payer: Health Management Network Commercial |
$81.60
|
| Rate for Payer: Humana Medicare |
$86.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$86.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$48.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$86.40
|
| Rate for Payer: MDX Hawaii PPO |
$93.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$86.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$86.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$86.40
|
| Rate for Payer: University Health Alliance Commercial |
$34.26
|
|
|
HCHG DETECT AGENT NOS DNA AMP - 90
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
H3060799
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$478.17 |
| Rate for Payer: AlohaCare Medicaid |
$241.50
|
| Rate for Payer: AlohaCare Medicare |
$434.70
|
| Rate for Payer: Cash Price |
$313.95
|
| Rate for Payer: Cash Price |
$313.95
|
| Rate for Payer: Devoted Health Medicare |
$478.17
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$48.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$43.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$434.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$50.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$410.55
|
| Rate for Payer: Humana Medicare |
$434.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$434.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$246.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$434.70
|
| Rate for Payer: MDX Hawaii PPO |
$468.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$434.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$434.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$434.70
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
